Game play with clients and patients

Brandon Ballantyne would like to see the use of therapeutic games expand outside of the counseling profession.

Ballantyne, a member of the American Counseling Association and the Pennsylvania Counseling Association, has long advocated for an increase in creative interventions within the counseling profession. In July he was able to present this idea outside of the profession as well — to a group of pediatricians at a continuing education program provided by his place of work, the Reading Hospital Center for Mental Health. His presentation focused on managing mild mental health issues in creative ways.

“I provided both research and personal experience that suggested the importance of using creative outlets such as games as a way to not only build trust with patients but also to offer safe, nonthreatening outlets for communication,” says Ballantyne, a licensed professional counselor who works with adolescent and adult clients in the partial hospitalization program at the Reading Hospital Center for Mental Health in Wyomissing, Pa. “I also provided information suggesting that the use of creativity can be used as a way to manage hostility and escalating acting-out behaviors. Working with resistance is a critical component in any health care setting, and the use of games with clients can introduce a safe outlet to channel energy that otherwise has potential to become problematic or aggressive in nature.”

During his presentation, Ballantyne suggested the use of games such as Risk, Monopoly and Life in the context of family therapy. Ballantyne finds games useful in this situation because they provide safe outlets for family members to explore their boundaries with each other. They also allow “the therapist to observe who is assertive and who is passive in the family,” Ballantyne says. “The therapist can make the family aware of these dynamics and invite passive members of the family to experiment with being more assertive. For example, a child who typically does what everyone else wants them to do may learn to initiate more communication during game play. As a result, this may improve the child’s confidence to initiate more communication with family members outside of game play as well.”

Ballantyne began to understand the importance of creativity in counseling during his time working on an adolescent inpatient unit within Reading Hospital.

“My colleague, Kevin Ulsh, and I began to notice the importance of redirecting the emotional energy of patients into healthier outlets,” Ballantyne says. “Together, we worked to develop a series of therapeutic activities that had a goal of redirecting emotional energy into the personal strengths of the patients. We learned that by utilizing a combination of artwork, games and journaling that our patients appeared to develop a discovery of how to use their talents as defenses against painful emotions. This resiliency is not only found in the adolescent population, but I believe it is a core characteristic of every human being.”

Ballantyne thinks that implementing creative strategies promotes a growing insight into a client’s thoughts and feelings. “It provides outlets for deeper exploration of self-concept, as well as flexible communication between the counselor and the client,” he says.

As Ballantyne told the group of pediatricians, therapeutic games can be beneficial outside of counseling, too. He is a firm believer that creative interventions can and perhaps should be utilized within a variety of health care settings.

“[The] primary foundation in health care is forming a helping relationship,” he explains. “At the core of every helping relationship, there should be a goal of developing a healthier individual, whether the goal is medical, physical, emotional or social.”

When using games in health care settings, the purpose has little to do with who actually wins the game, he says.

“Instead,” Ballantyne says, “the goal should be to utilize the context of the game itself to help difficult issues and feelings emerge within the client. Thus, providing a safe, nonthreatening outlet for the client to be able to practice working through stressors. In return, there will be a development of self-confidence which the client will then begin to apply to real-life situations.”

He notes that self-confidence in adolescents can be observed when they initiate a conversation about their thoughts, feelings, wants and desires.

“An adolescent who is able to discuss what he or she would like to see different about family dynamic has likely [developed] the confidence to communicate without the fear of disappointing their family members,” Ballantyne says. “Different family systems reinforce different communication patterns. Game play can be used to help the therapist observe the dynamics and provide a safe invitation for certain family members to experiment with different levels of assertiveness. Maybe, eventually, the child who used to simply accept everyone else’s debt in the game of Monopoly will learn the confidence to say, ‘no.’ As a result, the child may also then begin to set much-needed boundaries with other family members and friends outside of game play. [This promotes] a healthier belief about communication [while] offering practice with setting limits and boundaries.”

Counselors should be aware of a client’s potential emotional issues before trying this approach, Ballantyne says.

“If your client has a difficult time with frustration tolerance, it might be helpful to create opportunities to experience frustration during game play,” he suggests. “This provides an experience during which the client can experience a difficult emotion and then also experience support from the therapist to work through the difficult emotion. This personal growth can be facilitated completely within the context of a game and then be encouraged to be applied to real-life situations.”

Ballantyne stresses the importance of fostering a working alliance between all professionals in the health care field because, he says, it “will create an overall more productive, client-focused approach to treatment.”

By facilitating more collaboration between doctors and counselors, Ballantyne says, “we can have the opportunity to gather a more accurate patient history. By having a more complete and accurate patient history, we can more effectively evaluate the unresolved issues and problematic patterns that continue to exist in the client’s life, thus creating a more thorough approach to the overall care of the client across the entire role that health care serves in their life.”

Families, too, can take advantage of the beneficial nature of game playing, Ballantyne says.

“This allows for a strengthening of the value that family members place [on] each other,” he explains. “Families who do not spend regularly scheduled time together may have a more difficult time resolving conflict when it occurs. By having a regularly scheduled family game night, an expectation of closeness and trust is developed. It reinforces the balance of family roles by providing accountability and provides a safe, nonthreatening outlet to practice communication. These are all concepts that can be applied to daily stressors within the family. This makes the goal of resolving conflict within the family more achievable because these interpersonal skills have been practiced routinely.”

In Ballantyne’s experience, using games in therapy provides an effective outlet for clients to express their of thoughts and feelings.

“It is difficult to make progress in therapy if the counselor is not able to engage the client in active conversation,” Ballantyne explains. “[For example], for counselors working with children who have been victims of abuse, this can be very difficult because it is possible that the child is operating from a worldview that is intimidating and scary. The child may be constantly on guard. Sitting in a room with a counselor who they have just met may be a task that becomes very rapidly overwhelming. Therefore, the use of games in counseling can not only reinforce the healthy expression of emotions, but it can also serve as a bridge to trust between the counselor and the client.”

Games can also help to create more flexible boundaries between the counselor and the client.

“While the counselor is still probably viewed as the counselor during game play,” Ballantyne says, “they assume an extra role as the counselor who is also willing to engage a therapeutically competitive role as well.”

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I strongly agree with Ballantyne’s approach. The approach goes related to art therapy as well as the Montessori approach where children are exposed to play as well as learning life situations. They are able to learn social and emotional skills to communicate their emotions in healtier ways.
I have used art to work with clients who are in impatient programs for mental health disorders, and it works great to assist them to express their feelings, as well as to identify their state of mind.

Great article! I also use a wide variety of games, with great success, in my counseling work with clients of all ages. In addition to some of the games mentioned in the article, I also find cooperative games like Pandemic and Forbidden Island to be wonderful to teaching social skills, problem solving, and teamwork.

I’ve even developed and self-published my own deck of cards that comes with over a dozen activities and games called Describe.